减重手术、医学减重与上呼吸消化道

文献信息

中文摘要

肥胖和有意减重通过机械、代谢、炎症、胃肠道及局部软组织效应日益影响耳鼻咽喉科疾病。本综述探讨减重手术和当代医学减重疗法如何影响上呼吸消化道。证据最强的是阻塞性睡眠呼吸暂停，其中大幅减重可改善疾病严重程度，但并不能确保缓解。新出现的数据提示对慢性鼻窦炎和部分嗓音结局可能有获益，同时也存在风险，如术式特异性反流、慢性咳嗽、胃排空延迟、营养并发症以及咽鼓管异常开放功能障碍。耳鼻咽喉科医师应将减重方法、幅度、速度和持久性纳入评估、咨询和围手术期计划。

英文摘要

Obesity and intentional weight loss increasingly influence otolaryngologic disease through mechanical, metabolic, inflammatory, gastrointestinal, and regional soft-tissue effects. This review examines how bariatric surgery and contemporary medical weight-loss therapies affect the upper aerodigestive tract. Evidence is strongest for obstructive sleep apnea, in which substantial weight reduction improves disease severity but does not ensure remission. Emerging data suggest potential benefits for chronic rhinosinusitis and selected voice outcomes, alongside risks such as procedure-specific reflux, chronic cough, delayed gastric emptying, nutritional complications, and patulous Eustachian tube dysfunction. Otolaryngologists should incorporate the weight-loss method, magnitude, rate, and durability into evaluation, counseling, and perioperative planning.